MEDICARE: CLEMENTINE MARGUERITE FOUCHER MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program	R79417	AZ

General Provider Information

NPI Number	:	1932785789
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CLEMENTINE MARGUERITE FOUCHER MD

Provider Business Mailing Address
First Line	:	1501 N CAMPBELL AVE RM 5301B
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85724-5058
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1501 N CAMPBELL AVE RM 5301B
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85724-5058
Country	:	US
Telephone Number	:	520-626-7747
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/22/2021
Last Update Date	:	12/17/2025

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